Hanging Columella Reduction Under Local Anesthesia

In a rhinoplasty 5 years ago my nasal bones were narrowed and tip rotated up. When I smile my nose looks pinched with an excessively wide alar base, and my columella hangs far below the tip giving my nose a cartoonish "hook" down. I have heard that is possible to have a septal reduction to lift the columella under local anesthesia, if that's the main problem. I'd like to avoid a full revision surgery if possible. Is this recommended? How can I find a surgeon who does this? What would it cost?

Doctor Answers 13

Rhinoplasty correction can be done under local anesthesia.


1) We use local anesthesia with some sedation. The important thing is to have a board certified anesthesiologist for safety.

2) When you correct one part of the nose (hanging collumella), it has implications for other parts. So the surgeon has to be free to do what's necessary as the operation proceeds and the anatomy changes.

Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Columellar show and rhinoplasty

The nasolabial angle will determine whether the columellar reduction should be performed under local anesthesia.  I perform these in my practice and use this tool as a guide. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Treatment of hanging columella

The hanging columella is often more complex than what may be apparent.  Although some hanging columellas may be improved with a relatively easy procedure under local, many other hanging columellas require additional techniques and use of IV sedation

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.6 out of 5 stars 222 reviews

Hanging columella reduction

Certainly a tip plasty procedure can be done on the nose. The membranous and cartilaginous caudal septum are trimmed, bringing the columella up and inwards. Occasionally composite grafts have been put in the nostril rims to bring the alar rims down if they are retracted upwards. The tip plasty can be done under local anesthesia, but for most rhinoplasty procedures we do them under general anesthesia so that there is no conscious awareness while the procedure is being performed.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Hanging Columella and Wide Alar Base

The hanging columella can be corrected and the alar base narrowed under local anesthesia. A careful examination will determine what is necessary, but you do not need a full revision. Costs will be clarified before surgery, but do vary depending on geographic location and who does the work.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Can Columella Reduction Be Done Under Local Anesthesia?

Without an examination and side views, it is difficult to give a definitive answer.

However, in most cases the cause of hanging columella is excess soft tissue between the columella and the septum, which can be removed under local anesthesia in the office.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon
4.7 out of 5 stars 13 reviews

Office Correction of Hanging Columella

Dear 199543 in NY

To answer your question: I have performed what we call a "caudal trim" for a hanging columella in my office under only local anesthesia. The body part is basically "external". Good luck. 

Richard Sadove, MD
Gainesville Plastic Surgeon
4.8 out of 5 stars 20 reviews

Hanging columella

Without a full exam, it is hard to say.  Certainly rhinoplasty work can be done under sedation. I do not like doing things under local on this area, because of the discomfort.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Revision Rhinoplasty Hanging Columella Under Local Anesthesia

Looking at the one photo provided, it does appear that you have a hanging columella and a wide nasal base. Without seeing other views, it is somewhat difficult to determine what would be best in terms of a revision rhinoplasty procedure. Strictly speaking, the hanging columella can be addressed successfully under local anesthesia. This involves injecting an anesthetic solution in and around the bottom of the nose. The columella can then be approached with an incision made along both sides with subsequent adjustments made through this approach. Make sure you consult with a revision rhinoplasty specialist who has photos of other patients they have done using this technique. Good luck.

John M. Hilinski, MD
San Diego Facial Plastic Surgeon
4.7 out of 5 stars 35 reviews

Your hanging columella may require revision rhinoplasty surgery.

I read your concern, and I reviewed the photo you posted. You may require revision rhinoplasty performed with general anestheitc to prevent your columella from hooking down when you smile. I doubt you would get significant improvement by having only your septum reduced under local anesthetic.

You'll likely need to have your tip supported with a cartilage graft (C-strut), and have your lower lateral cartilages divided to allow your columella to rise up. Septal shortening may be performed at the same operation.

All the best from NJ.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 397 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.